JP2006000655A - Minimally invasive stitching instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a stitching instrument useful for implanting suture in tissue (e.g., cartilaginous tissue). <P>SOLUTION: The instrument has a frame and an elongated tubular member mounted thereto. A suture capture needle having a suture capture opening extends from a distal end of the tube. A needle cannula having a lumen is slidably mounted in a passage of the tubular member. Actuation of a trigger member pivotally mounted to the frame moves a distal end of the cannula needle and a section of suture contained in a lumen in the cannula needle through the suture capture opening, causing the suture section to be retained in the opening. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The technical field to which the present invention relates relates to soft tissue repair, and in particular to cartilage repair by suturing.

(Background of the Invention)
Injuries that damage cartilage (especially knee cartilage) are very common. Injuries that damage cartilage can occur while playing sports; at work; or as a result of an accident such as a fall or a car accident. The cartilage of the knee joint (eg, the meniscus) serves both the purpose of supporting the joint and the purpose of providing a sliding surface that is engaged by the ends of the bones in the knee. Injuries to the knee cartilage can cause knee instability and pain over time and can degrade the articulating surfaces of those bones, thereby causing arthritis Sometimes. Medicine has progressed on the treatment of damaged cartilage tissue, including meniscal cartilage tissue. Traditionally, it has been believed that cartilage tissue cannot be healed because the amount of transfusion associated with cartilage is typically limited to a minimum. Typical surgical procedures involved excising all or most of the damaged cartilage to restore some limited joint function. Currently, it is known that the body can heal damaged cartilage tissue. Damaged or lacerated cartilage tissue may typically be approached so that the damaged tissue can be healed. Various instruments and methods for repairing damaged cartilage tissue can be utilized. The most basic instrument is a conventional surgical suture. Damage to the cartilage tissue (typically a laceration) is held close by the suture in a fixed position using a surgical needle and suture to perform the repair. Suture is typically a procedure used in surgical procedures with incisions.

  It is known in the art to use minimally invasive procedures on the knee to repair soft tissue, including cartilage. In view of arthroscopic repair methods, various tissue fixation devices and application tools have been developed. One example of a meniscal repair device is a meniscal screw that is inserted across the laceration in the cartilage to bring or approximate the edges of the laceration. Meniscal screws are disclosed in US Pat. Nos. 5,569,252; 5,730,744; and 6,468,277. These US patent specifications are incorporated by reference. Another type of meniscal repair device is a “H-shaped” fastener. Such fasteners are disclosed in U.S. Patent Nos. 5,085,661; 5,320,633; 5,467,786; 5,470,337; 5,601, 571; and 5,941,439. These US patent specifications are incorporated by reference. Combination suture and back anchor devices for repairing meniscal tears are described in US Pat. Nos. 4,994,074; 6,047,826; 306,159; 6,319,271; and 6,432,123. These US patent specifications are incorporated by reference.

  Such fasteners are useful in arthroscopic tissue repair methods, but in this technique for new and improved instruments and methods for repairing soft tissue (eg, cartilage), There is a need. When repairing a laceration in a soft tissue (eg, cartilage tissue) of a joint, it is desirable to leave behind the minimum amount required in the implant to perform the repair. Sutures are typically known to provide a minimum amount for implantation. However, it requires a needle passage completely through the joint capsule and a second subsequent incision; then tie the ends together by hand; in an arthroscopic method, suture into the cartilage tissue It is known that installing yarn is difficult and requires considerable precautions. Risks associated with such methods include the risk of damaging the neurovascular structure; either by needle punctures or cuts; or by inadvertently wrapping sutures around them; The

  Accordingly, there is a need in the art for a novel suturing instrument and method for repairing soft tissue that is useful in minimally invasive surgical methods (especially arthroscopic surgical repair methods). Is present.

  An instrument for suturing tissue in a minimally invasive surgical method is disclosed. The instrument is particularly useful for suturing torn cartilage tissue by arthroscopic surgical methods. The instrument includes a hollow frame having an internal opening. A handle is attached to the frame. A trigger member is attached to the grip so as to rotate around the pivot axis. An elongated tubular member is attached to the grip. The tubular member has a distal end, a proximal end and an internal passage. A trocar is slidably mounted in the frame cavity and the elongated tube passage. The trocar has a proximal end; a distal end; a lumen; an opening at the distal end; a longitudinal axis; and a piercing point extending from the distal end. A needle member is mounted in the passage of the elongated tubular member. The needle member has a proximal end and a distal end. A capture needle extends from the distal end of the needle member. The capture needle has a distal puncture point and a suture capture opening. The capture needles are arranged in such a way that the longitudinal axis of the trocar intersects the capture opening. A locking member is slidably attached in the internal cavity of the frame. The helical spring is mounted in the cavity in such a manner that compression of the helical spring provides a proximal biasing force on the locking member. The trigger member secures the locking member and rotates the trigger member in such a manner that the distal end of the trocar moves through the suture capture opening. And the trocar moves in the distal direction.

  Yet another aspect of the present invention is a method of installing a suture in tissue using the tissue suturing instrument described above. These and other aspects and advantages of the present invention will become more apparent from the following description and accompanying drawings.

The minimally invasive suturing device of the present invention is preferably designed to be a single-use disposable device, but is optionally reusable; or some disposable elements May be designed to be reusable using
The minimally invasive suturing instrument of the present invention has many advantages. While using these instruments, it is possible to access a tissue site in a minimally invasive manner and implant a suture to approach the tissue. Minimally invasive suture instruments have additional advantages. These benefits include “all inside” repairs where the needle does not extend out of the joint capsule while reducing the possibility of colliding with neurovascular structures within the joint. Furthermore, there is no need to make a second incision like the “Inside-Out” suture technique or the “Outside-In” suture technique. In addition, the sutures are more evenly placed than when using traditional techniques. Because there is a certain distance between the needles, giving a uniform separation between the suture holes, and a non-uniform “bite” of the tissue. Because it gives.

  Although the invention has been shown and described in connection with detailed aspects thereof, various changes may be made in the form and details of those aspects without departing from the spirit and scope of the invention as set forth in the claims. It will be appreciated by those skilled in the art that changes can be made.

(Detailed description of the invention)
1-3 illustrate a meniscal repair device 5 of the present invention. The meniscal repair device 5 is considered to have a hollow frame 10. The frame 10 is also contemplated to have a top section 20 and a bottom section 30. The top section 20 can be attached to the bottom section 30 via tabs 32 and grooves 22. A handle grip 40 extends downward from the bottom section 30. The grip 40 is preferably hollow and is intended to have an internal cavity 42, a top 44, and a bottom 46. Extending distally from the top 44 is an opposing trigger mounting knob 50 having an axial pin opening 55. The distal end 14 of the frame 10 includes an opening 18. The opening 18 preferably has a slotted configuration, but may have other geometric structures, usually corresponding to the components exiting the cavity 15. It has a structure that can be done. The tubular member 60 is contemplated to have a proximal end 62, a distal end 64, and a passage 66. The tubular member 60 is also contemplated to have a proximal opening 61 and a distal opening. A proximal section of the proximal end 62 of the tubular member 60 is not shown, but may optionally extend through the opening 18 into the cavity 15 of the frame 10. A disc member 70 is mounted in the cavity 14 adjacent to the opening 18. The disc member 70 is contemplated to have a proximal surface 72, a distal surface 73, and side surfaces 74 and an axial opening 79. The spring support member 80 is contemplated to be a cylindrical member having a proximal end 81, a distal end 82, an inner passage 83 and an outer surface 84. A pair of opposing slots 88 extend from the outer surface 84 to the inner passage 83. The distal end 82 is attached to the proximal surface 72 of the disc member 70. Plunger rod 90 is contemplated to be a tubular member having an outer surface 96, a distal end 94, a proximal end 92 and a passage 98. The plunger rod 90 is slidably attached in the passage 83 of the support member 80. Extending from the outer surface 96 is an opposing guide member 95 that is engaged in the groove 88. The plunger member 100 is also considered to be slidably mounted in the cavity 15. Member 100 is contemplated to be a cylindrical member having a distal end 102, a proximal end 104, an outer surface 106 and a passageway 108. Extending from the outer surface 106 of the proximal end 104 is an engagement collar 110. The retaining ring 110 is an annular member having a proximal surface 112 and a distal surface 114. A push rod engagement member 130 having a proximal end 132 and a distal end 134 is mounted in the passage 108 and through the proximal end 12 of the frame 10. Extending rearwardly, a disc member 138 is attached to the distal end 134. The suturing push rod 140 is contemplated to have a proximal end 142 and a distal end 144. The proximal end 142 of the push rod 140 is attached to the disc member 138. The sewing push rod 140 is slidably mounted in the passage 98 of the plunger rod 90 and the passage 158 of the trocar 150. A spring member 120 is mounted on the spring support member 80 and the plunger rod 90. The spring member 120 is preferably a helical spring. The spring member 120 is contemplated to have a proximal end 122, a distal end 124 and an internal passage 126. The proximal end 122 of the spring member 120 is fixed to the locking ring 110, while the distal end 124 is fixed to the disc member 70. The trocar 150 is adapted to be slidably mounted in the passage 66 of the tubular member 60. The trocar 150 is contemplated to be a tubular member having an inner passage or inner lumen 158, a proximal end 152, a proximal opening 153, a distal end 154 and an opening 155. The distal end 154 is contemplated to be a sharpened piercing point 156 extending in the distal direction. The proximal end 152 is adapted to extend through the opening 18 into the cavity 14, through the opening 79 in the disc member 70 and into the passage 98 of the plunger rod 90, and Attached to the proximal end 102 of the plunger member 100. A capture needle 180 is fixedly mounted in the lumen 66 of the tubular member 60. The capture needle 180 is contemplated to be an elongated tubular member having a proximal end 184 attached to the disc member 70 and a distal end 186. As seen in FIGS. 4 and 5, a piercing capture member 190 extends outwardly from the distal end 186. The capture member 190 preferably has an arcuate structure. The member 190 has a top 191; bottom 192; proximal end 193; distal end 194; and a piercing tip 195 having a tip 196 and optional cutting edges 198; Has been. A suture capture opening 200 is included in the capture member 190. The capture opening 200 preferably has a keyhole-shaped structure, but may have other geometric structures. The opening 200 is contemplated to have a central section 202. The central section 202 is substantially oval, but may have other structures including circles and the like. A tapered engagement opening 205 is contemplated to communicate with the central section 202. Optional support bar 230 is adapted to be fixedly mounted within passage 66 of tubular member 60 between capture needle 180 and trocar 150. Support bar 230 is contemplated to have a proximal end 232 and a distal end 234. Proximal end 232 is attached to distal surface 73 of disc member 70. A trigger member 240 is attached to the handle attachment knob 50 of the grip 40 so as to rotate as a pivot axis. The trigger member 240 is considered to have an upper end 244 and a lower end 242. The pivot pin 246 is designed to extend outward from the upper end 244. The pivot pin 244 is mounted in the opening 55 of the knob member 50 such that the trigger member 240 can rotate about the pin 244. Extending into the cavity 15 from the top of the trigger member 240 is an opposing locking member 248 of an engagement yoke 247.

  The instrument 5 of the present invention is operated in the following manner. Initially, the first end 305 of the suture 300 is loaded through the distal opening 155 of the trocar 150 and into the passage 158 of the trocar 150 at the distal end 154. The second end 307 of the suture 300 is folded proximally to form a trailing end 310 and a suture loop 315. When the trigger member 240 is pulled in the proximal direction, the trigger member 240 thereby rotates about the pivot pin member 246. Yoke members 248 then cause plunger member 100 and plunger rod 90 to move as trocar 150 slides forward or distally within passageways (83 and 66). The locking ring 110 is fixed while being moved forward; on the other hand, the compression spring 80 is compressed while applying a biasing force to the locking ring 110 in the proximal direction. At the same time, the guide member 95 moves in the distal direction in the groove 88. The trigger member 240 continues to rotate until the distal end 154 having the suture ring 315 moves through the opening 200 and into the capture member 190. As a result, the suture ring 315 is fixed or captured in the locking opening 205 of the keyhole-shaped opening 200. When the trigger member 240 is released, the compression spring 80 allows the plunger member 100 and plunger rod 90 along with the trocar 150 to extend and move proximally; They are returned to their rest position and the section 305 of the suture 150 is released from the passage 158. The first end 305 of the suture 300 is a push rod locking member 130, if desired or necessary, and the distal end 144 of the push rod 140 is within the lumen 158. The first end 305 of the needle 150 through the passage 98 of the plunger rod 90 and through the passage or lumen 158 of the trocar 150 to secure and push the suture push rod 140 The push rod locking member 130 that moves in the lateral direction can be pushed out of the passage or lumen 158 of the trocar 150 by pushing it in the distal direction.

  4-6 illustrate surgical repair of lacerated meniscal tissue using the suturing instrument 5 of the present invention. The half moon 400 is considered to have a laceration 410. The laceration 410 is considered such that the opposing side surfaces 412 are separated by an opening 415. Prior to accessing the surgical site, the surgeon opens the distal opening in such a manner that the unsecured second end 307 of the suture 300 hangs outside the instrument 5 to form a loop 315 and a terminal end 310. Through portion 155, the first end 305 of a conventional suture 300 is passed through the passage or lumen 158 of the trocar 150. The surgeon inserts the distal end 64 of the tubular member 60 through a portal or opening to access the half moon 400 and then within the half moon 400 through which the suture is implanted. A piercing capture member needle 190 is placed adjacent to the laceration 410. The surgeon then moves the instrument 5 to the laceration 410 in the half-moon 400 in such a way that the piercing needle member 190 moves through the half-moon 400 around the laceration 410 or partially out of the half-moon 400. Move or push distally toward it. The surgeon then activates the trigger member 240 to move the distal end 154 of the trocar 150 and the suture ring 315 distally through the meniscus 400 around the laceration 410. As the distal end 154 of the trocar 150 exits the meniscus 400, the distal end 154 moves through the capture opening 200 in the capture member 190. The surgeon then releases the trigger member 240 and slides the suture ring 315 in the capture opening 200 into the tapered locking section 205 when the needle 150 moves back from the half-moon 400 back into the rest position. Let hold. The surgeon then moves the instrument 5 in the proximal direction. Then, as the capture member 190 moves proximally through the half moon 400, the section of the suture 300 that includes the annulus 315 follows, and eventually leaves the half moon 400 with the capture member 190. At this stage, the surgeon has installed the suture portion of the suture 300 around the laceration 410, and then tauts the suture 300 and ties the suture 300 with a conventional surgical knot, and so on. , Close the facing sides to close the opening 415 and complete the repair of the laceration 410. Alternatively, the surgeon installs the desired number of suture portions of the suture and then repeats the procedure to place additional sutures in the meniscus by placing a conventional surgical knot. Can be selected. Although it is preferred to form the loop 315 of the suture 100, it is not necessary and a single strand of the suture 300 can be captured at the opening 200.

Although the method of use related to the method of repairing cartilage has been described, the suturing instrument 5 of the present invention is a minimally invasive method in which it is desirable to install a suture in a tissue. The invasive method can be used in any method, including, but not limited to, mirror methods and laparoscopic methods. The instrument of the present invention may also be useful in incision methods.
The minimally invasive suturing device of the present invention can be made from conventional biocompatible materials. These materials include 300 series stainless steel, aluminum, and biocompatible plastics (eg, polycarbonate, ABS, Delrin, etc.). Sutures that can be used with the suturing instrument and method of the present invention include conventional biocompatible absorbable and non-absorbable sutures. The size of the suture is sufficient to provide effective resistance to any load or force applied over the half moon. For example, suture sizes may range from about USP # 2/0 to about USP # 2 for conventional sizes.

Specific embodiments of the present invention are as follows.
(1) a hollow frame having an internal cavity;
A grip attached to the frame;
A trigger member attached to the grip for rotation about a pivot axis;
An elongate tube attached to the frame, the elongate tube having a distal end, a proximal end, and an internal passage;
A trocar mounted slidably within the frame cavity and the elongated tube passage, the proximal end, the distal end, the lumen, and an opening at the distal end; The trocar having a longitudinal axis and a piercing point extending from the distal end;
A needle member mounted in the passage of the elongate tube having a distal end;
A capture needle extending from the distal end of the needle member having a distal piercing point and a suture capture opening, such that the longitudinal axis of the trocar intersects the capture opening The capture needle being disposed on;
A locking member slidably mounted in an internal cavity of the frame; and a proximal biasing force on the locking member by a helical spring compression force; The helical spring mounted in the cavity;
The trigger member fixes the locking member, and when the trigger member rotates, the distal end of the trocar passes through the suture capture opening. The tissue suturing instrument, wherein the locking member and the trocar are moved in a distal direction in such a manner that the locking member and the trocar move in the distal direction.
(2) The suture instrument according to the embodiment (1), wherein the suture capture opening in the capture needle includes a keyhole shape.
(3) The suturing instrument according to the embodiment (2), wherein the capture opening includes a suture locking groove.
(4) The suturing instrument according to the above embodiment (1), further comprising an end portion of a suture thread that is attached in the passage of the trocar.
(5) The suturing instrument according to the embodiment (1), wherein the capture needle is bent.

(6) The suturing instrument according to the above embodiment (1), further comprising a suture push rod attached in a slidable state in the lumen of the trocar.
(7) The suturing instrument according to the embodiment (1), wherein the top end of the trigger member includes a yoke.
(8) The suturing instrument according to the embodiment (1), further including a support member in the passage of the tube.
(9) In a method of placing a suture in tissue,
I. A hollow frame having an internal cavity;
A grip attached to the frame;
A trigger member attached to the grip for rotation about a pivot axis;
An elongate tube attached to the frame, the elongate tube having a distal end, a proximal end, and an internal passage;
A trocar mounted slidably within the frame cavity and the elongated tube passage, the proximal end, the distal end, the lumen, and an opening at the distal end; The trocar having a longitudinal axis and a piercing point extending from the distal end;
A needle member mounted in the passage of the elongate tube having a distal end;
A capture needle extending from a distal end of the needle member having a distal piercing point and a suture capture opening, wherein the trocar longitudinal axis intersects the capture opening. The capture needle;
A locking member slidably mounted in an internal cavity of the frame; and a proximal biasing force on the locking member by a helical spring compression force such that the cavity The helical spring mounted in the
Providing a tissue suturing instrument comprising: the trigger member securing the locking member; and rotating the trigger member causes the distal end of the trocar to move the suture. Moving the locking member and the trocar in a distal direction such that it moves through the capture opening;
II. Loading the end of the suture into the lumen of the trocar;
III. Moving the capture needle through tissue;
IV. In order to move the distal end of the trocar and the section of suture through tissue such that the section of suture is partially secured by the suture capture aperture, the trigger member is Drawing step; and V. Pulling the instrument proximally to pull the capture needle and the suture section outward from the tissue, thereby installing the suture seam in the tissue;
Including the above-mentioned arrangement method.
(10) The method according to embodiment (9), wherein the suture capture opening in the capture needle includes a keyhole shape.

(11) The method according to the embodiment (10), wherein the capture opening includes a suture fixing groove.
(12) The method according to the embodiment (9), wherein the capture needle is bent.
(13) The method according to the above embodiment (9), wherein the suturing instrument further includes a suture push rod attached to the trocar lumen so as to be slidable.
(14) The method according to the embodiment (9), wherein the top end of the trigger member has a yoke.
(15) The method according to the above embodiment (9), wherein the suturing device further includes a support member in the passage of the tube.

It is a perspective view of the soft tissue suture instrument of the present invention. FIG. 2 is a side cross-sectional view of the instrument of FIG. 1 illustrating the trigger in the activated position. FIG. 2 is a cross-sectional view of the instrument of FIG. 1 illustrating the instrument with the trigger in a rest position. FIG. 2 is a partial plan view of the distal end of the instrument of FIG. 1 illustrating the trocar in a distal actuation position. FIG. 2 is a partial plan view of the distal end of the instrument of FIG. 1 illustrating the trocar in a proximal rest position. Fig. 6 illustrates a meniscal repair device that is used to implant a suture in the cartilage of the knee to repair the knee laceration. Fig. 6 illustrates a meniscal repair device that is used to implant a suture in the cartilage of the knee to repair the knee laceration. Fig. 6 illustrates a meniscal repair device that is used to implant a suture in the cartilage of the knee to repair the knee laceration.

Explanation of symbols

5 Half-moon repair instrument; suture instrument 10 hollow frame 12 proximal end of frame 10 distal end of frame 10; cavity 15 cavity 18 opening 20 top section 22 groove 30 bottom section 32 knob 40 grip 42 internal cavity 44 top 46 bottom 50 knob 55 axial pin opening 60 tubular member 61 proximal opening 62 proximal end 64 distal end 66 passage; lumen 68 distal opening 70 disc member 72 proximal surface 73 distal surface 74 side surface 79 axial opening 80 Compression spring; spring support member 81 proximal end 82 distal end 83 inner passage 84 outer surface 88 groove 90 plunger rod 92 proximal end 94 distal end 95 guide member 96 outer surface 98 passage 100 plunger member 102 distal end 104 Proximal end 106 Outer surface 108 Passage 110 Lock ring 112 Proximal surface 114 Distal surface 1 0 spring member 122 proximal end 124 distal end 126 internal passage 130 push rod locking member 132 proximal end 134 distal end 138 disc member 140 suture push rod 142 proximal end 144 distal end 150 trocar; Suture 152 proximal end 153 proximal opening 154 distal end 155 opening 156 piercing point 158 inner passage 180 capture needle 184 proximal end 186 distal end 190 piercing capture member; piercing needle member 191 top 192 bottom 193 proximal end 194 distal end 195 piercing tip 196 tip 198 cutting end 200 suture capture opening 202 central section 205 taper locking opening; taper locking section 230 support bar 232 proximal end 234 distal end 240 trigger member 242 lower end 244 upper end 246 pivot Shaft pin 247 Locking yoke 248 Locking member 248 Yoke part 300 suture 305 first end; suture 150 section 307 second end 310 terminating 315 suture loop 400 meniscal 410 lacerations 412 side 415 opening

Claims (9)

A hollow frame having an internal cavity;
A grip attached to the frame;
A trigger member attached to the grip for rotation about a pivot axis;
An elongate tube attached to the frame, the elongate tube having a distal end, a proximal end, and an internal passage;
A trocar mounted slidably within the frame cavity and the elongated tube passage, the proximal end, the distal end, the lumen, and an opening at the distal end; The trocar having a longitudinal axis and a piercing point extending from the distal end;
A needle member mounted in the passage of the elongate tube having a distal end;
A capture needle extending from the distal end of the needle member having a distal piercing point and a suture capture opening, such that the longitudinal axis of the trocar intersects the capture opening The capture needle being disposed on;
A locking member slidably mounted in an internal cavity of the frame; and a proximal biasing force on the locking member by a helical spring compression force; The helical spring mounted in the cavity;
The trigger member fixes the locking member, and when the trigger member rotates, the distal end of the trocar passes through the suture capture opening. The tissue suturing instrument, wherein the locking member and the trocar are moved in a distal direction in such a manner that the locking member and the trocar move in the distal direction.   The suturing instrument according to claim 1, wherein the suture capture opening in the capture needle includes a keyhole shape.   The suturing instrument according to claim 2, wherein the capture opening includes a suture locking groove.   The suturing instrument according to claim 1, further comprising a suture end mounted in the trocar passage.   The suturing device according to claim 1, wherein the capture needle is bent.   The suturing instrument according to claim 1, further comprising a suture push rod mounted slidably in the lumen of the trocar.   The suturing instrument according to claim 1, wherein the top end of the trigger member comprises a yoke.   The suturing instrument according to claim 1, further comprising a support member in the passage of the tube. In a method of placing a suture in tissue,
I. A hollow frame having an internal cavity;
A grip attached to the frame;
A trigger member attached to the grip for rotation about a pivot axis;
An elongate tube attached to the frame, the elongate tube having a distal end, a proximal end, and an internal passage;
A trocar mounted slidably within the frame cavity and the elongated tube passage, the proximal end, the distal end, the lumen, and an opening at the distal end; The trocar having a longitudinal axis and a piercing point extending from the distal end;
A needle member mounted in the passage of the elongate tube having a distal end;
A capture needle extending from a distal end of the needle member having a distal piercing point and a suture capture opening, wherein the trocar longitudinal axis intersects the capture opening. The capture needle;
A locking member slidably mounted in an internal cavity of the frame; and a proximal biasing force on the locking member by a helical spring compression force such that the cavity The helical spring mounted in the
Providing a tissue suturing instrument comprising: the trigger member securing the locking member; and rotating the trigger member causes the distal end of the trocar to move the suture. Moving the locking member and the trocar in a distal direction such that it moves through the capture opening;
II. Loading the end of the suture into the lumen of the trocar;
III. Moving the capture needle through tissue;
IV. In order to move the distal end of the trocar and the section of suture through tissue such that the section of suture is partially secured by the suture capture aperture, the trigger member is Drawing step; and V. Pulling the instrument proximally to pull the capture needle and the suture section outward from the tissue, thereby installing the suture seam in the tissue;
Including the above-mentioned arrangement method.

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